Methods, systems, and apparatuses for tissue ablation using electrolysis and permeabilization

ABSTRACT

Example apparatuses and systems are disclosed for providing controlled delivery of electrolysis treatment and cellular permeabilization treatment to a site in tissue. A system disclosed may include an electrode, a power supply, and a controller. The controller may control a charge applied to the electrode to induce a direct current through the aqueous matrix to produce electrolysis products and a voltage to produce electroporation. The duration and magnitude of the charge applied may determine the dose of the products and the degree of the permeabilization of cells in the treatment site. The composition of the electrodes may be chosen in accordance with the desired products produced and electroporation effects. An apparatus is disclosed that may be in the form of electrodes for electrolysis and electrodes for electroporation applied to the tissue. An apparatus is disclosed that may be used for treating internal tissue.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This application is a continuation of U.S. patent application Ser. No.16/509,416 filed Jul. 11, 2019, which is a continuation of U.S. patentapplication Ser. No. 15/036,393 filed May 12, 2016, which is a U.S.national stage application of PCT Application No. PCT/US2014/065794filed Nov. 14, 2014, which claims priority to provisional applicationsU.S. Ser. No. 61/904,142 filed on Nov. 14, 2013, U.S. Ser. No.61/921,084 filed on Dec. 27, 2013, and U.S. Ser. No. 61/938,623 filed onFeb. 11, 2014.

The entire disclosures of the afore-mentioned applications areconsidered to be part of the disclosure of the instant application andare hereby incorporated by reference in their entirety for any purpose.

BACKGROUND

Electrolysis has been used for minimally invasive tissue ablation sincethe early 1800's. The process of electrolysis occurs at the electrodesurfaces for electrodes submerged in an ionic conducting media. Newchemical species are generated at the interface of the electrodes as aresult of the electric potential driven transfer between electrons andions or atoms. The various chemical species produced near the electrodesdiffuse away in a process driven by differences in electrochemicalpotential. In physiological solutions these chemical reactions alsoyield changes in pH, resulting in an acidic region near the anode and abasic region near the cathode. Tissue ablation is driven by two factors:a cytotoxic environment developing due to local changes in pH, as wellas the presence of some of the new chemical species formed duringelectrolysis. Electrolysis is a chemical ablation mechanism, and theextent of ablation is a function of the concentration of the chemicalspecies and the exposure time to these chemicals. The total amount ofelectrolytic products generated during electrolysis is related to thecharge delivered during the process, and therefore the total charge isused as a quantitative measure for the extent of electrolysis.

Over the last two decades, substantial research has been done on tissueablation by products of the electrolysis process in ionic aqueoussolutions, including cell and animal experiments, mathematical modeling,and clinical work. In the contemporary literature, electrolytic ablationusing products of electrolysis generated from tissue ions and moleculesis sometimes referred to as Electro-Chemical Therapy (EChT). Unlessspecifically stated otherwise, the terms “the products of electrolysis”and “electrolysis products” refer to products generated from thetransfer and removal of electrons to ions and molecules in an ionicaqueous solution and involve only the components of the aqueous solutionor tissue as an aqueous solution. Unless stated otherwise, the processof electrolysis implies the use of inert electrodes that do notparticipate in the process of electrolysis except as a source or sink ofelectrons or as catalysts. This is also how electrolysis is defined inEChT. As used herein, “electrolysis” or “electrolytic” refers to theprocess of electrolysis and the products of electrolysis as definedabove. Electrolytic ablation has been shown to exhibit several uniqueattributes. First, due to the chemical nature of the ablation process,the diffusion of chemical species in the tissue and the rate of chemicalreactions dominate the time scale of the procedure. Second, the chemicalproducts at the anode differ from those formed at the cathode, thusresulting in distinct mechanisms of ablation. Finally, electro-osmoticforces drive the migration of water from the anode to the cathode,further magnifying the contrasting physiological effects at theelectrode surfaces. From an operational standpoint, electrolysis may usevery low voltages and currents, providing advantages relative to otherablation techniques, e.g. reduced instrumentation complexity. It is,however, a lengthy procedure, controlled by the process of diffusion andthe need for high concentrations of electrolytically-produced ablativechemical species.

Electroporation also harnesses an electricity-induced phenomenon; itdiffers from electrolysis by employing a different set of biophysicalprinciples. The bioelectric phenomenon of electroporation ischaracterized by the permeabilization of the cell membrane through theapplication of very brief, high-magnitude electric field pulses. Theextent of membrane permeabilization is a function of the electric fieldstrength. Electroporation can be used to produce reversible pores,defects, in the lipid bilayer, allowing for the introduction ofmolecules such as genes and drugs into cells. This is generally referredto as “reversible electroporation” The electric parameters, however, canbe designed to produce irreversible defects in the cell membrane,resulting in a cell membrane that does not reseal after the field isremoved. This is referred to as “irreversible electroporation”.Reversible electroporation techniques have been combined with anticancerdrugs such as bleomycin to target cancerous tissues for successfulclinical use in the field of electrochemotherapy. Reversibleelectroporation is also used in other medical and biotechnologicalapplications, including transfection and introduction of molecules suchas siRNA into cells that survive the permeabilization process.Electroporation specifically targets the cell membrane through theapplication of an electric field that develops instantaneously.Irreversible electroporation may be used for tissue ablation.

SUMMARY

An example method for targeted tissue ablation may includepermeabilizing cell membranes in the targeted tissue and deliveringelectrolysis products to the targeted tissue, wherein the electrolysisproducts may be toxic to the cells in the tissue.

An example apparatus for tissue ablation may include a source ofelectrolysis products, wherein the source of electrolysis products maybe positioned proximal the targeted tissue and a device that may beconfigured to permeabilize cell membranes in the targeted tissue.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other features of the present disclosure will becomemore fully apparent from the following description and appended claims,taken in conjunction with the accompanying drawings. Understanding thatthese drawings depict only several examples in accordance with thedisclosure and are, therefore, not to be considered limiting of itsscope, the disclosure will be described with additional specificity anddetail through use of the accompanying drawings, in which

FIG. 1 is a schematic illustration of an electrolysis system accordingto an embodiment of the disclosure.

FIG. 2A is a flow chart illustrating a method according to an embodimentof the disclosure.

FIG. 2B is a flow chart illustrating a method according to an embodimentof the disclosure.

FIG. 3 is a schematic diagram of a treatment probe according to anembodiment of the disclosure.

FIG. 4 is a schematic diagram of a treatment probe according to anembodiment of the disclosure.

FIG. 5A illustrates an electrode configurations according to anembodiment of the disclosure.

FIG. 5B illustrates an electrode configuration according to anembodiments of the disclosure.

FIG. 6A is a schematic diagram of a balloon catheter according to anembodiment of the disclosure.

FIG. 6B is a schematic diagram of a balloon catheter according to anembodiment of the disclosure.

FIG. 7 is a schematic illustration of an electrolysis device accordingto an embodiment of the disclosure.

DETAILED DESCRIPTION

Certain details are set forth below to provide a sufficientunderstanding of embodiments of the disclosure. However, it will beclear to one skilled in the art that embodiments of the disclosure maybe practiced without these particular details. Moreover, the particularembodiments of the present disclosure described herein are provided byway of example and should not be used to limit the scope of theinvention to these particular embodiments. In other instances,well-known materials, components, processes, controller components,software, circuitry, timing diagrams, and/or anatomy have not beendescribed or shown in detail in order to avoid unnecessarily obscuringthe embodiments.

This disclosure describes the combined effect of electroporation withelectrolysis which may allow for more effective ablation of tissue.Combining electroporation with electrolysis may produce a substantialincrease in the extent of tissue ablation as compared to the ablationproduced by the same dose of electrolysis or electroporation separately.Without being bound by a particular theory, this phenomenon may beattributed to the electrolytically produced chemicals that may passthrough a permeabilized cell membrane into the interior of the cell,thereby causing cell damage at much lower concentrations of electrolyticproducts than for intact cells. This mechanism of tissue ablation may beaffected by the dose of chemical species produced by electrolysis at theelectrodes, the process of electro-osmotic diffusion from the electrodesinto tissue and the permeabilization of the cell membrane in thetargeted tissue.

Electrolysis generally refers to a process of inducing anelectrochemical reaction that involves passing a direct current throughan ionic solution via two electrodes. Electrolysis may facilitate theremoval and/or addition of electrons from atoms and/or ions, which maylead to the formation of new products. For example, by passing a DCcurrent through a saline solution (NaCl and H₂O), hypochlorous acid(HClO) may be formed. The products formed may be based, at least inpart, on the ionic composition of the solution, pH, and/or materialsincluded in the electrodes. The amount of electrolysis products formedmay be based at least in part on the magnitude of the current and/or theduration the current is applied. The current may be generated bycoupling a power source to the electrodes. Examples of power sources mayinclude, but are not limited to, one or more, electrical network,batteries, a computer (e.g., coupled via USB cable), a solar cell, andcombinations thereof.

Electrolysis products may be used for sterilization and/or ablation oftissue. Some electrolysis products, which may be generated from the ionsand molecules of the aqueous solution, such as hypochlorous acidpreviously mentioned, may be toxic to cells and/or organisms.Hypochlorous acid and other electrolysis products may be introduced to atissue by pouring or injecting a solution including the electrolysisproducts to a targeted tissue. However, electrolysis products degraderapidly over time, reducing their effectiveness. In tissue ablation byproducts of electrolysis applications, it may be desired to produce theelectrolysis products at the tissue site.

Electrodes for performing electrolysis may be placed in contact with atissue or a solution in contact with the tissue. It may be advantageousto use inert electrodes, because the products of electrolysis arespecifically defined from the composition of the solution. When theelectrodes are activated, electrolysis products may form from the ionsand molecules in the tissue and/or solution and diffuse throughout thetarget volume of tissue. Cells within the target site may be ablated.Electrolysis may be used in combination with other treatments such asthermal ablation, cryotherapy, cellular permeabilization, and/orcombinations thereof. The permeabilization of cells may increase thediffusion of electrolysis products into the cells of the target volumeof tissue. This may enhance the effectiveness of electrolysis therapyand/or reduce the amount of electrolysis products required to achieve adesired effect.

In some embodiments, electrolysis may be used in combination withelectroporation and/or other cellular permeabilization treatment. Thecombination treatment may be more effective at ablation and/orsterilization than the individual treatments used alone. The combinationof electrolysis with another treatment may generally be referred to as“multimodality electrolysis” herein.

An example method of tissue ablation through the delivery of products ofelectrolysis to a targeted volume of tissue, in combination with thepermeabilizing of the cell membrane of the cells in targeted volume oftissue may include: bringing electrode needles to the proximity of thetargeted volume of tissue, delivering electric potential to theelectrodes to generate electric fields that permeabilize the cellmembrane in the targeted volume of tissue, delivering electric currentto the electrodes for generating the electrolytic products at theelectrodes at an amount sufficient to ablate permeabilized cells in thetargeted volume of tissue, and electro-osmotic diffusion of theelectrolytic products throughout the targeted volume of tissue.Permeabilization and production of electrolytic products may be done inany sequence that achieves the goal of bringing the products to thecells in the targeted volume of tissue and at the same timepermeabilizing these cells, such as permeabilizing the volume of cellsin tissue first and generating the required amount of products ofelectrolysis next, generating the amount of electrolytic products firstand permeabilizing the cell membrane next, simultaneously permeabilizingthe cell membrane and producing the products of electrolysis, or anycombination of these.

FIG. 1 is a schematic illustration of a multimodality electrolysissystem 100 according to an embodiment of the disclosure. Themultimodality electrolysis system 100 may be capable of performingelectrolysis and at least one other treatment, such as cellularpermeabilization treatment. Although the system 100 in FIG. 1 is shownon the surface of a tissue 10, the system 100 may be configured to beused inside tissue 10, proximate tissue 10, and/or in a cavity formed bytissue 10 in some embodiments. In some embodiments, the system 100 mayinclude a controller 105 coupled to an electrolysis device 110 and acellular permeabilization device 115. Although shown as separate devicesin some embodiments the electrolysis device 110 and the cellularpermeabilization device 115 may be the same device. The devices 110, 115may be placed proximate to a treatment site on tissue 10.

The controller 105 may control the timing, strength, and duration oftreatments provided by the devices 110, 115. The controller 105 may, forexample, be programmed to provide an electronic signal to the devices110, 115. The electronic signal may be indicative of a dose oftreatment, for example, a dose of electrolysis products. The electronicsignal may control the timing and magnitude of a current generated bythe electrolysis device 110 and/or the cellular permeabilization device115, which may be implemented as an electroporation device. This mayallow a user to customize treatment of the tissue 10. In someembodiments, the controller is coupled to a power supply 120. In someembodiments, the power supply 120 may be included in device 110 and/ordevice 115. In some embodiments, the power supply 120 is integrated withcontroller 105.

Although shown as a separate component coupled to the devices 110, 115,in some embodiments, the controller 105 may be integrated into one orboth devices 110, 115 and/or packaged together with one or both devices110, 115. In some embodiments, the controller 105 may include aprogrammable chip coupled to the devices 110, 115. Some embodiments, thecontroller 105 may be implemented using a computing device (not shown)and be remotely coupled to the devices 110, 115. The computing devicemay be implemented using, for example, a microprocessor, a desktop,laptop, server, handheld device, a personal computer, a tablet computer,and/or a smart phone. In some examples, the computing device may beintegrated with and/or shared with another piece of medical equipment.The controller 105 may be coupled by a wire or communicate with thedevices 110, 115 wirelessly. In some embodiments, two separatecontrollers may be used in system 100. Each controller may be coupled toone of the devices 110, 115.

In some embodiments, the controller 105 may be programmed to provide anelectronic signal indicative of a dose of the electrolysis productsand/or a permeability level of cells. The controller 105 may, forexample, include such a program, or include one or more processingdevices (e.g. processors) coupled to a memory encoded with executableinstructions for electrolysis treatment and at least one othertreatment, such as cellular permeabilization treatment.

The system 100 may further include one or more sensors for measurementof pH 125, electric field strength 130, and/or other properties of thetissue 10. For example, the sensor may sense pH near the electrolysisdevice 110 and provide the pH value to the controller 105. Thecontroller 105 may further be programmed to adjust an electronic signalprovided to the electrolysis device 110 based on the pH near the device.A reservoir (not shown) may be provided for addition of compounds, suchas buffers or other solutions, to the aqueous matrix to adjust the pH.In another example the pH sensor 125, may be inserted at the outer edgeof the targeted volume of tissue to detect when the pH at the site hasreached a desired level which may ensure the ablation of tissue at thatsite. This may be used as an indicator by the controller 105 to stop theelectrolysis process. In another example the pH sensor 125, may beinserted at a particular site in tissue to detect when the pH at thesite is reaching a potentially damaging value to avoid tissue damage atthat site. This may be used as an indicator by the controller to stopthe electrolysis process. In some examples the electric meter 130 may beset at a particular location in tissue to measure isoelectric fieldlevels which may ensure that the cells at that location arepermeabilized. The electric meter 130 may be implemented as anelectrical conductivity meter.

In some embodiments, the electrolysis device 110 includes one or moreelectrodes for conducting a current through a solution. The solution maybe native to the treatment site and/or it may be introduced to thetreatment site. In some embodiments, the electrolysis device 110includes an aqueous matrix in contact with the electrodes for placementproximate the treatment site. In some embodiments, the aqueous matrixmay be a gel including a saline solution. In some embodiments the salinesolution may be at a pH of between 3 and 5, such as a pH of 4. In someembodiments, the electrolysis device 110 may be a treatment pad forsurface treatments. In some embodiments, the electrolysis device 110 mayinclude needle electrodes and/or a catheter for use within cavitiesand/or tissues.

The cellular permeabilization device 115 may perform reversible and/orirreversible permeabilization. In some embodiments, the cellularpermeabilization device 115 is an electroporation device. Theelectroporation device may include one or more electrodes for generatinga potential difference across tissue for permeabilizing cells. Thepermeability of the cells and/or the reversibility of thepermeabilization may be based, at least in part, on the magnitude of thelocal electric field in tissue and/or duration of the electroporationtreatment. In some embodiments, the cellular permeabilization device 115is a sonoporation device, which may use ultrasound for permeabilization.In some embodiments, the cellular permeabilization device 115 mayimplement another permeabilization method such as, but not limited to,cryosurgery, freezing, coldporation, heatporation, and chemoporation.

In some embodiments, electrolysis device 110 may be packaged with thecellular permeabilization device 115. In some embodiments, theelectrolysis device 110 and cellular permeabilization device 115 may bea single device. For example, the electrodes for performing electrolysismay also be used for performing electroporation.

In some embodiments the combination electrolysis and permeabilizationmay be combined with other modalities for tissue treatment such asthermal ablation, radiation, chemical ablation, and/or gene therapy.

FIGS. 2A and 2B are flow charts illustrating methods 200A, 200Baccording to embodiments of the disclosure. In some embodiments, amultimodality electrolysis system, device, and/or apparatus may beplaced for treatment of a target site, for example, a tissue. Themultimodality electrolysis system such as the system 100 illustrated inFIG. 1 may be used. The treatments performed by the multimodalityelectrolysis system may be manually controlled by a user or may becontrolled by a controller, for example, controller 105 shown in FIG. 1.Generally, delivery of electrolysis products may be performed before,during, or after permeabilizing cells in a tissue to be treated. Asdescribed herein, in some examples, permeabilizing the cells before,during, and/or after delivery of the electrolysis products may improvethe effectiveness of the electrolysis products in ablating the tissue.

In method 200A, electrolysis is performed at Block 205. The electrolysismay deliver electrolysis products to the target site. Electrolysis maybe followed by cellular permeabilization at Block 210. Cells at thetarget site may have increased permeability in response to the cellularpermeabilization, which may enhance delivery of the electrolysisproducts. Although not shown, Block 205 may be repeated after Block 210in some embodiments. In some embodiments, Blocks 205 and 210 may berepeated in an alternating fashion for a desired period of time. Blocks205 and 210 may be of different time durations, magnitudes, and/or otherdiffering parameters. In some embodiments, Blocks 205 and 210 may beseparated by a period of time where no treatment is applied to thetarget site.

In method 200B, cellular permeabilization is performed at Block 215.Cells at the target site may have increased permeability in response tothe cellular permeabilization. Electrolysis may be performed followingcellular permeabilization at Block 220. The electrolysis may deliverelectrolysis products to the target site. Although not shown, Block 215may be repeated after Block 220 in some embodiments. In someembodiments, Blocks 215 and 220 may be repeated in an alternatingfashion for a desired period of time. Blocks 215 and 220 may be ofdifferent time durations, magnitudes, and/or other differing parameters.In some embodiments, Blocks 215 and 220 may be separated by a period oftime where no treatment is applied to the target site.

In some embodiments, electrolysis and cellular permeabilization may beperformed at the same time or partially at the same time. For example,current to generate electrolysis products may be provided during a sameperiod of time as an electric field for electroporation, or current as athermal source for permeabilizing cell membranes is applied to thetissue. In some embodiments, electrolysis and cellular permeabilizationmay both be performed together for a continuous period of time orintermittently. In some embodiments, one treatment may be performedcontinuously while the other treatment is performed intermittently. Themagnitude and duration of each treatment may be modulated independentlyof the other treatment. For example, electrolysis may be performedcontinuously for several minutes while cellular permeabilization may beperformed for several seconds each minute. The electrolysis may bediscontinued while the cellular permeabilization continues to beperformed. Other combinations of treatments may be possible. The time,duration, and order of the treatments may be chosen based at least inpart on the desired effect on the target site, the size of the targetsite, and/or local physiological conditions of the target site.

In some embodiments, electrodes may be included on and/or in a treatmentprobe which may produce one of, or both electrolysis and electroporationtreatment. For example, the treatment probe may be used to execute themethods described above and/or illustrated in FIGS. 2A-B. In someembodiments, the treatment probe may be used to implement anelectrolysis device and/or an electroporation device, such as devices110, 115 illustrated in FIG. 1. In some embodiments, the treatment probemay be a combination device used to implement both devices 110, 115. Thetreatment probe may be implemented using a point, needle, a wire, a pad,a disk, and/or combinations thereof. In some embodiments, the electrodeor electrodes may include the entire treatment probe. In someembodiments, the electrode or electrodes may be included as a portion ofthe treatment probe.

FIG. 3 is a schematic diagram of a treatment probe 300 according to anembodiment of the disclosure. The treatment probe 300 may incorporateboth electroporation electrodes 305 and electrolysis electrodes 310. Theelectrodes for electroporation 305 may be separate from the electrodesfor electrolysis 310. Having separate electrodes for each treatmentmodality may allow for independent optimization of the electrodeconfiguration for both electroporation and electrolysis. For example,the electrode design for electrolysis may include materials that areselected for specific electrolysis product species production, such asTi coated with IrO to favor production of hypochlorous acid. Theelectrode material for electroporation may be selected to avoidelectrolysis product formation that may result in bubble formation,which may lead to arcing. The electrodes may be in any number, size andshape of electrodes using a separate electrode delivery approach.

FIG. 4 is a schematic diagram of a treatment probe 400 according to anembodiment of the disclosure. In some embodiments, a treatment probe mayintegrate the electrodes 405, 410 for electrolysis and electroporation.The electrodes for electrolysis, or certain ones of the electrodes, maybe the same electrodes, or certain ones of the electrodes, that deliverelectroporation. The electrodes may be in any number, size and shapeusing an integrated electrode approach. A number of differentconfigurations may be used to integrate the delivery of electroporationand electrolysis into a catheter. The size, shape and configuration ofthe electrodes may be specifically tailored to the targeted treatmentsite.

In some embodiments, a treatment probe may include a combination ofelectrodes used for both electrolysis and electroporation delivery. Forexample, an electrode may be used for both electroporation andelectrolysis. A separate electrode may be used to complete theelectroporation delivery and a separate electrode may be used tocomplete the electrolysis delivery. In some embodiments, the electrodesmay be included on a plurality of treatment probes. For example, a firstprobe may include the electrolysis anode and a second probe may includethe electrolysis cathode. The first and second probes may furtherinclude electroporation electrodes. Other examples of electrodecombinations include, but are not limited to, two point electrodes, onepoint and one needle electrode, one point electrode and one padelectrode, two monopolar needle electrodes; one bipolar needle, onemultipolar needle; two surface electrodes; one surface and one needleelectrode, and/or combinations thereof. Other configurations ofelectrodes on one or more treatment probes may also be possible. Thespacing between electrodes on the treatment probe and/or the spacingbetween treatment probes may also be adjusted to achieve a desiredelectrolysis and/or electroporation effect.

FIGS. 5A-B illustrate two examples of electrode configurations 700A-Baccording to embodiments of the disclosure. FIG. 5A illustrates twoneedle electrodes 705, 710 inserted in a tissue 70. FIG. 5B illustratesa point electrode 720 on an insulated shaft 715 inserted in a tissue 70.A pad electrode 725 is placed remotely from the point electrode 720. Insome embodiments, the point electrode 720 may be an anode and the padelectrode 725 may be a cathode. The examples shown in FIG. 5A-B are forillustrative purposes only, and other electrode configurations arepossible.

In some embodiments, one or more treatment probes and/or electrodes maybe integrated into a catheter. The catheter may include one or morelumens. Each lumen may include one or more treatment probes. Theelectrodes for delivering the treatments may be in any combination,shape or size sufficient to deliver both electroporation andelectrolysis to the treatment site. The delivery of the combinationelectroporation and electrolysis by catheter may allow for a multitudeof clinical applications, including nerve ablation, renal denervation,atrial fibrillation, arrhythmias, deep vein thrombosis, percutaneoustransvascular applications, restenosis and other lumen based treatmentsites. A catheter approach may also be utilized for the treatment of avariety of tumors accessible by catheter such as lung, liver, prostate,colon, bladder, rectal, and esophageal cancers. A catheter or needleapproach could also be used for ablation of fat for cosmetic purpose.

FIGS. 6A-B are schematic diagrams of balloon catheters 500A-B configuredto provide electrolysis and electroporation treatment according toembodiments of the disclosure. Balloon catheter 500A includes electrodes505 deposited on a balloon surface 510. The electrodes 505 are used toprovide both electrolysis and electroporation. Balloon catheter 500Bincludes separate electrolysis electrodes 520 and electroporationelectrodes 525 deposited on a balloon surface 530. In some embodiments,the electrodes 505, 520, 525 may be deposited on a catheter shaft 515,535 in addition to or alternatively to the balloon 510, 530. The number,size and shape of the electrodes may be tailored for the specifictreatment site.

Electrodes for electrolysis and/or electroporation may be integratedwith other catheter designs. For example, spring electrodes that may beexpanded and/or contracted may be used. In another example, electrodesmay be integrated with a stent included with a catheter. In anotherexample, electrodes may be integrated on the surface of a balloon havinga ring shape. The ring-shape may allow the electrodes to contact atissue surface, such as a blood vessel wall, while allowing a flow ofmaterial through the central portion of the ring. Other catheter designsmay be used.

FIG. 7 is a schematic illustration of a multi-modality electrolysisdevice 600 according to an embodiment of the disclosure. In someembodiments, the multi-modality electrolysis device 600 may be used forthe treatment of surface wounds and/or other tissue surfaces. The device600 may include at least one electrode 610 and an aqueous matrix 605 incontract with the electrode. Generally, the electrode 610 and theaqueous matrix 605 may be selected such that electrolysis products areproduced when a current is passed through the aqueous matrix 605 usingthe electrode 610. The electrode 610 may also deliver electroporationtreatment. The electrode 610 and aqueous matrix 605 may be packaged forplacement proximate the site to which delivery of electrolysis productsand electroporation is desired. In FIG. 7, an electrode 610 and aqueousmatrix 605 are shown packaged in a pad 615. In some embodiments, the pad615 may include an adhesive strip 620 for securing the pad 615 to adesired site. Further examples of devices and pads that may be adaptedfor use with permeabilizing techniques are described in PCT ApplicationSerial No. PCT/US2014/065783 filed Nov. 14, 2014, entitled “METHODS,SYSTEMS, AND APPARATUSES FOR DELIVERY OF ELECTROLYSIS PRODUCTS,” whichapplication is incorporated by reference herein in its entirety for anypurpose.

In some embodiments, electrode 610 may include a plurality ofelectrodes. One or more electrodes may deliver electrolysis treatmentand one or more electrodes may deliver electroporation treatment. Theelectrode 610 and/or a plurality of electrodes may include one or morematerials. Electrode materials for electrolysis treatment are generallyselected to include a material that is selected to produce theelectrolysis products when a current is passed through the aqueousmatrix 605 using the electrode 610. The materials chosen for theelectrodes, including the electrode 610, may be chosen to producecertain the electrolysis products. For example, an anode may includeiridium oxide and/or rubidium oxide deposited on titanium, which mayimprove the production of hypochlorous acid, and a cathode may includecopper. The use of mixed metal oxide anode electrodes may producedifferent species of electrolysis products that may be tailored fordifferent clinical needs. For example, platinum may be used if inertelectrodes are desired or silver electrodes or silver/silver chloride,and/or copper electrodes if silver ions or copper ions are desired inthe electrolytically produced solution, which may further enhance thetissue ablation effect. While metal ions produced by electrolysis fromelectrodes may enhance the tissue ablation effect of electrolysis theymay also cause gene alteration or introduce toxic heavy metals in thebody. Heavy metals may stay in the body for life, with detrimentaleffects. In contrast, when the products of electrolysis are thosegenerated by the electrolysis of the ionic solution in tissue, theseproducts may have a very short lifetime and may have no long termnegative effect. Electroporation electrodes may include the same ordifferent materials as electrolysis electrodes.

Although shown as a surface pad electrode 610 in FIG. 7, one or moreelectrodes may be implemented as a needle, a catheter, point electrode,other electrode configuration, and/or combination of configurations.

In some embodiments, electrodes may be separated by an insulating layer.The insulating layer may be implemented using any suitable insulatingmaterial. In some embodiments, the insulating layer between theelectrodes may be omitted. In some embodiments, a portion of the aqueousmatrix 605 is between the electrodes. In some embodiments, a portion ofthe aqueous matrix 605 is between the electrode 610 and the pad 615.

One or more of the electrodes in the device 600, such as the electrode610 may be externally-accessible for receipt of an electronic signalfrom a controller (not shown), which may be placed remotely from thedevice 600. The controller may be implemented as controller 105 shown inFIG. 1. The controller may activate the electrode 610 and control thedelivery of electrolysis treatment and electroporation treatment. Thecontroller may control the magnitude and duration of each treatmenttype.

Apparatuses, devices, and systems described herein may include anaqueous matrix in contract with at least one electrode. The aqueousmatrix 605 is shown in FIG. 7 in contact with electrode 610. Aqueousmatrices described herein, including the aqueous matrix 605, may includecomponents for forming electrolysis products. In some embodiments, theaqueous matrix 605 may be implemented using a gel and/or hydrogel. Theaqueous matrix may include a saline solution. The aqueous matrix mayhave a pH selected to produce electrolysis products, such ashypochlorous acid. In some examples, the pH of the aqueous matrix 605may range between 2 and 5. The aqueous matrix 605 may be placed incontact with a site for delivery of electrolysis products, such as bylaying a pad including the aqueous matrix 605 on the site.

In some embodiments, the aqueous matrix 605 may include a low pH salinesolution hydrogel (e.g. about 4 pH) that is configured for theproduction of hypochlorous acid. The materials included in the solutionincluded in the aqueous matrix 605 may be chosen to produce the desiredelectrolysis products, such as hypochlorous acid). In some embodiments,the aqueous matrix 605 may have a higher electrical conductivity thanthe site for delivery of electrolysis products. The higher electricalconductivity of the aqueous matrix 605 may result in electrolysisproducts produced primarily in the aqueous matrix 605, not the tissue atthe site. The ionic composition of the aqueous matrix 605 may bedesigned to have the desired conductivity but to include different ionsfrom those normally in tissue, for example a greater concentration of Naor Ca. In some embodiments, the aqueous matrix 605 may be infused with adrug for combination therapy at the treatment site. That is, both thedrug and electrolysis products are delivered to the treatment site. Insome embodiments, the aqueous matrix 605 may be designed to have adesired conductivity and/or pH to enhance electroporation treatment.

In some embodiments, aqueous matrices described herein, such as theaqueous matrix 605, may be implemented using a liquid solution. Theliquid solution may be prepared separately and applied directly to thetreatment site before placement of a device, such as device 600. In someembodiments, the device 600 may be placed at the treatment site and theaqueous matrix 605 may be introduced to the treatment site by injectingit through a port (not shown) in the pad 615. In some embodiments, thepad 615 includes a dehydrated gel. Before use, the gel may be hydratedwith a solution, such as saline, to form the aqueous matrix 605. In someembodiments, the aqueous matrix 605 is already present in the device600.

The apparatuses, devices, and systems, such as treatment probes,catheters, and pads may all be used to deliver multimodalityelectrolysis. Other configurations, apparatuses, devices, and/or systemsfor delivering multimodality electrolysis may also be used. For example,one or more needle electrodes may be used in combination with anultrasound transducer configured to provide sonoporation. Electrolysistreatment may also be combined with cryotherapy, thermal therapy,chemical therapy, and/or combinations thereof. For example a cryosurgeryprobe may also serve as one of the electrolysis electrodes.

Many clinical applications may benefit from the use of the combinationof reversible electroporation and electrolysis. The reduced energyrequirement and reduce treatment times may overcome limitations thatpreviously discouraged the use of either electroporation or electrolysisregardless of the benefits of each on a stand-alone basis. Thecombination of both may overcome the limitations and enable a multitudeof clinical uses.

For example ablation of nerves by the combination of electroporation andelectrolysis include targeted lung denervation for chronic obstructivepulmonary disease, renal denervation and carotid body receptors forcongestive heart failure.

The treatment of atrial fibrillation by the combination of reversibleelectroporation and electrolysis may be an enhanced treatment approach.The catheter delivery approach of the combination of reversibleelectroporation and electrolysis may allow for a low energy,non-thermal, fast treatment option. The ability to tailor the treatmentapplication by electrode design also may allow the treatment to beconfigured to apply all elements of a full Cox procedure in a minimallyinvasive fashion.

Other vascular diseases may benefit from the combination treatment ofelectroporation and electrolysis. These include, but are not limited to,vascular lumen sites that are occluding like restenosis, peripheralartery disease, and deep vein thrombosis. Denervation for hypertension,cognitive heart disease and chronic obstructive pulmonary disease maybenefit from the combination of electroporation and electrolysis.

The treatment of a variety of cancers by the combination ofelectroporation and electrolysis may be an enhanced treatment approach.The targeted treatment site may be accessed minimally invasively byeither catheter or probe placement. The configuration of the device andthe electrodes may deliver the combination of electroporation andelectrolysis in an optimal manner for the targeted tumor. The types oftumors may include but are not limited to prostate, breast, lung, liver,brain, colon, esophagus, kidney, rectal, skin, stomach, pancreas, eyeand uterine tumors.

The combination of electroporation and electrolysis may be an effectiveclinical approach for both malignant and benign tumor treatments. Thusbenign tumor sites like Benign Prostatic Hypertrophy, fibroids andmyomas may be treated.

Another area that may benefit from the combination of electroporationand electrolysis is the treatment of wound infections or parasiteinfection in tissue. Any area that requires sterilization of a woundcould be treated by the combination of electroporation and electrolysis.The application of the combination of electroporation and electrolysismay be through catheter delivery, probe based or by a wound care padthat incorporates the ability to deliver both electroporation andelectrolysis. Diseases like bedsores (pressure ulcers), venous ulcers ordiabetic ulcers may be treated with the combination of reversibleelectroporation and electrolysis. Simple wounds that are pre infectionmay be treated preventatively with the combination of reversibleelectroporation and electrolysis. Surgical incisions may be treated withthe combination of electroporation and electrolysis which may preventinfections from occurring. When surgical incisions develop an infection,the combination of electroporation and electrolysis may be used to treatit. Chronic wound infections, including the treatment of biofilm couldbe treated with the combination of electroporation and electrolysis.

A multitude of cosmetic applications may benefit from the combination ofelectroporation and electrolysis. They include but are not limited toskin resurfacing, skin tightening, skin lesion removal, hair removal,wrinkle removal or reduction, and acne removal, reduction or prevention.Cosmetic applications can also be incorporated to treat unwanted area ofthe body, such as excess fat tissue ablation.

Another disease prevention approach includes the sterilization of foodssuch as meats by combination of reversible electroporation andelectrolysis. The combination of both electroporation and electrolysismay be an improvement over either used individually for this purpose.

Those skilled in the art will recognize that the examples provided ofboth the design delivery systems and the clinical applications are notthe limit of the uses of the combination of electroporation andelectrolysis in the treatment of tissue. Many configurations of deliverysystems exist, as well as applications that may benefit from the use ofthe discovery we disclose.

A variety of devices and or clinical applications can be made from a newmethod of combining sonoporation and electrolysis. For example, a woundcare pad may be made that incorporates a gel and an electrode(ultrasound transducer sufficient to cause US waves to producesonoporation) similar to the configuration of device 600 in FIG. 7. Thisnew pad may improve wound care by both protecting the treatment areawhile applying both sonoporation and electrolysis product at thetreatment site for optimal wound care disinfection. This device may beconfigured with a battery, connected to a generator or with anelectrolytic cell design. The types of wounds this may be applied toinclude but are not limited to bed sores, diabetic ulcers, burns, tears,gashes, cuts, scrapes, irradiation and scars formation.

In another clinical application, the device may be a wound care dressingthat may be applied over a large surface area. The wound care dressingmay incorporate a gel coating and an electrode configuration. Thisdevice may be configured with a battery, connected to a generator orwith an electrolytic cell. The wound care dressing may be applied to thetreatment site. The sonoporation pulses may be delivered before or afterthe application of the electrolysis product. The electrolysis productmay be diffused in the treatment area to disinfect the wound. The typesof wounds that this may be applied to include but are not limited to bedsores, diabetic ulcers, burns, tears, gashes, cuts, scrapes, irradiationand scars formation.

In another clinical application the device may be a cosmetic patch thatmay be applied to the surface of the skin. The patch may be shaped tomatch the area of treatment. The patch may have a gel coating,transducer, and electrode configuration that delivers sonoporationpulses before or after optimized electrolysis product are applied. Thecombined sonoporation and electrolysis treatment may result in acontrolled ablation of the skin surface or unwanted cosmetic feature.The healing process of this application may result in a tightening ofthe skin. This device may be configured with a battery, connected to agenerator or with an electrolytic cell.

In another clinical application the device may be a cosmetic patch thatmay be applied to the surface of the skin to provide a controlledchemical peel. The patch may be shaped to match the area of treatment.The patch may have a gel coating, transducer, and electrodeconfiguration that delivers sonoporation pulses before or afteroptimized electrolysis product are applied. The combined sonoporationand electrolysis treatment may result in the removal of dead layers ofskin. The healing process of this application may result in a tighteningof the skin. This device may be configured with a battery, connected toa generator, or with an electrolytic cell.

In another clinical application the device may be a cosmetic patch thatmay be applied to the surface of the skin to provide a controlledablation of the skin surface or unwanted cosmetic feature. The patch maybe shaped to match the area if treatment. The patch may have a gelcoating, transducer, and electrode configuration that deliverssonoporation pulses before or after optimized electrolysis product areapplied. The healing process of this application may result in atightening of the skin. This device can be configured with a battery orwith an electrolytic cell.

In another clinical application, surface based cancer sites may betreated with a combination treatment patch. The type of cancer sites tobe treated includes but is not limited to benign skin tumors, actinickeratosis, basal cell carcinoma, dysplastic nevi, melanoma, and squamouscell carcinoma. The patch may deliver sonoporation to open the targetedcancer cells and the electrolysis process delivers a specific amount ofelectrolysis product to cause cell death. This device may be configuredwith a microcontroller and feedback system to determine the completenessof the treatment.

In another clinical application surface based skin growths orirregularities may be treated with a combination treatment patch. Thetype of skin growths or irregularities to be treated includes but is notlimited to cysts, growths, lipomas, tags, acne, age spots, dark spots,wrinkles and warts. The patch may deliver sonoporation to open thetargeted irregular cells and the electrolysis process delivers aspecific amount of electrolysis product to cause cell death. This devicemay be configured with a microcontroller and feedback system todetermine the completeness of the treatment.

Additional applications may involve the placement of the gel on thesurface of a treatment area directly while placement of the electrodescreates the ability to form the electrolysis product at the site.

Another area that may benefit from the combination of sonoporation andelectrolysis is the treatment of wound infections. Any area thatrequires sterilization of wound debridement could be treated by thecombination of sonoporation and electrolysis. The application of thecombination of sonoporation and electrolysis may be through catheterdelivery, probe based or by a wound care pad that incorporates theability to deliver both sonoporation and electrolysis. Diseases likebedsores, or diabetic ulcers can be treated with the combination ofsonoporation and electrolysis. Simple wounds that are pre infection canbe treated preventatively with the combination of sonoporation andelectrolysis.

A multitude of cosmetic applications could benefit from the combinationof sonoporation and electrolysis. They include but are not limited toskin resurfacing, skin tightening, skin lesion removal, hair removal,wrinkle removal or reduction, and acne removal, reduction or prevention.Cosmetic applications can also be incorporated to treat unwanted area ofthe body, such as excess fat tissue.

Another disease prevention approach includes the sterilization of foodssuch as meats by combination of sonoporation and electrolysis. Thecombination of both sonoporation and electrolysis may be an improvementover either used individually for this purpose.

Another embodiment may include the combination of sonoporation andelectrolysis in a surgical probe. The probe may have a tip thatincorporates electrodes and transducer elements capable of deliveringsonoporation and electrolysis to a treatment site. The treatment sitemay be at the surface of a patient or inside a surgical cavity. Theprobe may be used to sterilize a treatment site. The probe may be usedto debride a wound site. The probes may be inserted into the body totreat an unwanted area such as fatty tissue.

Another embodiment may utilize a method to control the dose the amountof electrolysis product produced and applied to the treatment site. Adelivery device may be used to apply the electrolysis product producedat the time of application. For example a wound care pad may beconfigured to produce a specific amount of electrolysis product. Thewound care pad may be the delivery system that may ensure theapplication of the electrolysis product is done in a controlled fashion,such that the electrolysis product is in place for the duration of thetreatment. The wound care pad may incorporate an electrode design thatfacilitates the optimal production of electrolysis products. Theelectrodes may be connected to a DC power source. The power source maybe controlled by a controller so that its output is constant, pulsed, orother modulated pattern for a specific period of time or all the time.The wound care pad may also incorporate a gel pack filled with asolution or hydrogel. The amount of gel is designed to produce aspecific amount of electrolysis product over a period of time with aspecific amount of energy in coulombs applied. The gel may be housed ina protective pack that is broken prior to application on the wound. Thebreaking of the protective pack allows for the gel to come into contactwith the electrodes on the wound pad. Alternatively, a dry pad that isproduced from a saline or other optimized electrolysis environmentproduct can be used as a way to introduce control in the electrolysisproduct production.

A variety of devices and or clinical applications may be made from amethod of combining, freezing and cold, and electrolysis. Cryosurgery isa tissue ablation method that generally employs one or more probes,insulated except at the metal tip, to freeze and thereby ablateundesirable tissues. One of the advantages of cryosurgery may be thatthe extent of freezing may be monitored in real time with medicalimaging techniques, such as ultrasound. However, in the temperaturerange of from 0 C to about −20 C some cells may survive freezing andtherefore, the extent of freezing, as seen by medical imaging, does notnecessarily correspond to the extent of cell death. Pores and defectsmay open in the cell membrane in the temperature ranges below the phasetransition temperature for lipids, about +15 C, with the defectformation increasing down to subzero freezing temperatures. Furthermore,during freezing, the solutes in tissue may be rejected and concentratedbetween the ice crystals. These properties of cryosurgery may becombined with electrolysis, which may enhance the cell death from thatof cryosurgery and electrolysis alone.

For example, cryosurgery and electrolysis may be combined using asystem, such as the system shown in FIG. 1. The un-insulated metal tipof a cryosurgery probe may serve as one of the electrodes of theelectrolysis device 115. Connecting the un-insulated tip to the powersupply 120 may generate products of electrolysis, prior to the deliveryof cold and freezing. The extent of electrolysis may be determined fromtreatment planning or measurements with the pH meter 125. When theseshow that the desired electrolytic front has reached a desired location,the cryosurgery probe may be connected to a cooling system (not shown inFIG. 1) and freezing begins. Freezing may continue until the ice frontinterface reaches the desired extent of ablation, as shown by imagingmonitoring, e.g. ultrasound. The ice front may be at a temperature of−0.56 C and the temperature drops through the ice lesion to thetemperature of the cryo-probe. As indicated earlier the process ofcooling and freezing may open and permeabilize the cell membrane, whilethe process of freezing causes a concentration of the solutes in thefreezing solution, including an increase in the concentration of theproducts of electrolysis. The permeabilization of the cell membrane andthe increased concentration of products may introduce the products ofelectrolysis into cells and induce, after thawing, cell death throughoutthe entire frozen region, including in the temperature range in whichcells usually survive freezing. This may facilitate cell ablation bycryosurgery to the freezing interface as monitored by imaging, which mayimprove the accuracy and the effectiveness of cryosurgery.

The combination of permeabilization by cold and/or freezing andelectrolysis may be used for all the current applications ofcryosurgery, such as treatment of tumors, vascular treatment, ablationof fat in cosmetic surgery by cold alone, or by, cold and freezing,treatments in dermatology and cosmetics. The treatment of a variety oftumors by the combination of cryosurgery and/or cold and electrolysismay be an enhanced treatment approach. The targeted treatment site maybe accessed minimally invasively by either catheter or probe placement.The configuration of the device and the electrodes may deliver thecombination of cryosurgery or cold and electrolysis in an optimal mannerfor the targeted tumor. The types of tumors may include but are notlimited to prostate, breast, lung, liver, brain, colon, esophagus,kidney, rectal, skin, stomach, pancreas, eye and uterine tumors.

The combination of cryosurgery or cold and electrolysis may be aneffective clinical approach for both malignant and benign tumortreatments. Thus benign tumor sites like Benign Prostatic Hypertrophy,fibroids and myomas may be precisely treated under medical imagingmonitoring.

In some embodiments, one or more treatment probes and/or electrodes maybe integrated into a cryosurgery ablation catheter. The electrodes fordelivering the treatments may be in any combination, shape or sizesufficient to deliver both cryosurgery and electrolysis to the treatmentsite. The metal un-insulated part of the cryosurgery catheter may beused as at least one electrolysis electrode. The second electrode mayalso be on the catheter or in a remote location, including on thesurface of the body. The delivery of the combination cryosurgery andelectrolysis by catheter may allow for a multitude of clinicalapplications, including nerve ablation, renal denervation, atrialfibrillation, arrhythmias, deep vein thrombosis, percutaneoustransvascular applications, restenosis and other lumen based treatmentsites. A catheter approach may also be utilized for the treatment of avariety of tumors accessible by catheter such as lung, liver, prostate,colon, bladder, rectal and esophageal cancers. Other vascular diseasesmay benefit from the combination treatment of cryosurgery andelectrolysis. These include, but are not limited to, vascular lumensites that are occluding like restenosis, peripheral artery disease, anddeep vein thrombosis. Denervation for hypertension, cognitive heartdisease and chronic obstructive pulmonary disease would benefit from thecombination of electroporation and electrolysis.

A catheter or needle approach could be also used with the combinationfreezing, and/or cold and electrolysis for ablation of fat for cosmeticpurpose.

Other cosmetic applications of the combination cryosurgery, cooling andelectrolysis include but are not limited to skin resurfacing, skintightening, skin lesion removal, hair removal, wrinkle removal orreduction, and acne removal, reduction or prevention.

Other applications include various areas of dermatology. The type ofcancer sites to be treated on the skin includes but is not limited tobenign skin tumors, actinic keratosis, basal cell carcinoma, dysplasticnevi, melanoma, and squamous cell carcinoma.

Some specific experimental examples are provided below to facilitateappreciation of embodiments described herein. The experimental examplespresented are not intended to be comprehensive or exhaustive of allexperiments performed or of all results obtained.

Example I

According to a first non-limiting example, a Petri dish was used to castan agar gel made of physiological saline with a pH dye. The pH dye was5% pH indicator (RC Hagen wide range). The pH indicator was added to theagar gel phantom before its solidification. Two 0.9 mm graphiteelectrodes were inserted into the gel through a holder, similar to theelectrode configuration shown in FIG. 5A. Graphite was used to avoidcontamination of the gel with metal ions. The electrodes were connectedto a constant voltage power supply or to a BTX electroporation (HarvardInstruments) electroporator. The distance between the electrodes was 10mm. Changes in color near the electrodes were observed due toelectrolysis induced change in pH.

The first experiment involved the delivery of typical electroporationpulses of 1000 V between the electrodes. One hundred microsecond longpulses at a frequency of 1 Hz in groups of 99 pulses were delivered.Between groups of pulses, a two minute rest period was used to let thesystem cool.

The gel exhibited a stained region after 99 pulses. The stained regionsurrounded the electrodes and was not continuous, confirming thedelivery of electrolysis products. However, the extent of the stain didnot cover the treated tissue to the isoelectric field of 200 Vcm or 100V/cm line, produced by the 1000 V electroporation pulses. In typicalirreversible electroporation protocols used in current clinicalapplications for tissue ablation, fewer than 100 pulses are used. Underthese typical conditions there are no electrolysis products in theregion of electric fields of 100 V/cm or 200 V/cm. 200 V/cm and 100 V/cmare reversible electroporation fields that do not cause cell death inthe absence of electrolytic products.

After three sequences of 99 pulses, a substantial volume of gel in thetreated region has been affected by the products of electrolysis and haschanged the pH of the gel. However, even after 3×99 pulses, the regionaffected by electrolysis has not yet reached the 100 V/cm isoelectricfield line. The region affected by the anode was larger than thataffected by the cathode. In addition, in the center of the regionstained near the anode there was a white discolored circle. This may bedue to a typical effect of electrolysis. In electrolysis there is anelectro-osmotic driven flow of water from the anode to the cathode. Thisis a well-known phenomenon. This phenomenon may be used to generateflows in tissue during electrolysis in desirable directions.Furthermore, by adding electrolysis products by extending electrolysistreatment and/or introducing a solution configured for electrolysisproduct production, the treated zone may be substantially expanded.

Example II

According to a second non-limiting example, a Petri dish was used tocast an agar gel made of physiological saline with a pH dye. The pH dyewas 5% pH indicator (RC Hagen wide range). The pH indicator was added tothe agar gel phantom before its solidification. Two 0.9 mm graphiteelectrodes were inserted into the gel through a holder, similar to theconfiguration shown in FIG. 5A. Graphite was used to avoid contaminationof the gel with metal ions. The electrodes were connected to a constantvoltage power supply or to a BTX electroporation (Harvard Instruments)electroporator. The distance between the electrodes was 10 mm. Changesin color near the electrodes were observed due to electrolysis inducedchange in pH.

The second experiment involved the delivery of typical electroporationpulses of 500 V between the electrodes. One hundred microsecond longpulses at a frequency of 1 Hz in groups of 99 pulses were delivered.Between groups of pulses, a two minute rest period was used to let thesystem cool.

The pH affected area after three pulse sequences of 99 pulses and avoltage between electrodes of 500 V is smaller than when the pulse wasof 1000 V.

Example III

According to a third non-limiting example, a Petri dish was used to castan agar gel made of physiological saline with a pH dye. The pH dye was5% pH indicator (RC Hagen wide range). The pH indicator was added to theagar gel phantom before its solidification. Two 0.9 mm graphiteelectrodes were inserted into the gel through a holder, similar to theconfiguration shown in FIG. 5A. Graphite was used to avoid contaminationof the gel with metal ions. The electrodes were connected to a constantvoltage power supply or to a BTX electroporation (Harvard Instruments)electroporator. The distance between the electrodes was 10 mm.

The DC power supply applied a voltage of 10 V (a current of 60 mA)between the electrodes. It was evident that after 168 seconds the pH dyearea marked as affected by electrolysis products from direct current wasmuch larger than the area affected by electrolysis products generated byelectroporation pulses in Examples I and II. The pH change affected areawas sufficiently large so that a 1000 V pulse applied between theelectrodes may ablate to the isoelectric field line of 100 V/cm. 100V/cm is considered reversible electroporation and permeabilization ofthe cell membrane is typically done with eight pulses. Cells surviveexposure to electric fields of eight, 100 V/cm. However, whenelectrolytic products are generated in sufficient quantity to diffuse tothe 100 V/cm isoelectric-field lines, the cells exposed to eight 100V/cm electric fields do not survive. Therefore, it appeared that apreferential way to use the combination of electrolysis/electroporationfor tissue ablation is to use conventional electrolysis with relatively(compared to electroporation) long DC currents at low voltage andcurrent for the products of electrolysis to diffuse through the targetedvolume in combination with several high field electroporation typepulses that are sufficient to permeabilize the cell membrane. There maybe several possible combination protocols with electrolysis typecurrents and electroporation type pulses delivered in various sequencesand configurations. For instance: electrolysis first, electroporationlater or electroporation first electrolysis later, or electroporationfirst, electrolysis second and electrolysis again third or at differentintervals in time between electrolysis and electroporation.

Example IV

According to a fourth non-limiting example, a Petri dish was used tocast an agar gel made of physiological saline with a pH dye. The pH dyewas 5% pH indicator (RC Hagen wide range). The pH indicator was added tothe agar gel phantom before its solidification. Two 0.9 mm graphiteelectrodes were inserted into the gel through a holder, similar to theconfiguration shown in FIG. 5A. Graphite was used to avoid contaminationof the gel with metal ions. The electrodes were connected to a constantvoltage power supply or to a BTX electroporation (Harvard Instruments)electroporator. The distance between the electrodes was 10 mm.

A voltage of 5 V was applied across the electrodes with a current of 9mA. Staining indicated that this produced a comparable outcome toelectrolytic treatment with 10 V in Example III and is also suitable fortissue electrolysis/electroporation ablation protocol described inExample III. The center of the stained gel near the anode was discoloredbecause of the water electromigration effect.

Example V

Conventional tissue ablation by electroporation is delivered using twoelectrodes. The electrodes are positioned relatively close to each otherto facilitate high electric fields with reasonable voltages. It may beadvantageous to ablate tissue by electroporation in a modality similarto radio-frequency thermal ablation, i.e. one electrode in the center ofthe undesirable tissue and a second electrode remotely, similar to theelectrode configuration shown in FIG. 5B. However, a problem with thisconfiguration may be that for a single needle or point active electrodeswith a remote second electrode, the electric field near the needle orpoint electrode descends very rapidly with distance from the electrode.In the case of the needle electrode, as one over the distance square andin the case of a point electrode, as one over the distance to the thirdpower. Consequently the extent of tissue affected by irreversibleelectroporation is small.

According to a fifth, non-limiting example, a typical one dimensional incylindrical coordinates needle electrode was used. The central electrodewas 0.9 mm graphite and the second electrode was a lining of copperaround the wall of a Petri dish. The Petri dish was used to cast an agargel made of physiological saline with a pH dye. The pH dye was 5% pHindicator (RC Hagen wide range). The pH indicator was added to the agargel phantom before its solidification.

A sequence of electrolysis/electroporation treatment was applied with asingle central needle. The sequence started with electrolysis in which10 V, and 200 mA were induced between the electrodes. Two sets ofexperiments were performed, one set with the anode in the center and oneset with the cathode in the center. The gel was observed after 45seconds, 90 seconds, 120 seconds after start of electrolysis. Stainingwas observed around the electrode in both sets of experiments after 45seconds, and the stained area continued to increase as time went on. Theamount of electrolysis products observed in this set of experiments wassignificantly higher than for the case of two adjacent electrodes at thesame voltage in the previous examples. The reason may be that thecurrent was higher and/or possibly because the products from the anodeand cathode do not interact with each other due to the increaseddistance. These experiments suggest that it may be advantageous togenerate the electrolysis products from a central electrode with adistant second electrode. First the amount of electrolysis productsappears to be higher and the composition appears to be better defined.It may be preferable when two electrodes are used for electroporation touse one or both of these electrodes with one polarity and another remoteelectrode with another polarity for generating electrolysis products insome applications.

Example VI

According to a sixth non-limiting example, a typical one dimensional incylindrical coordinates needle electrode was used. The central electrodewas 0.9 mm graphite and the second electrode was a lining of copperaround the wall of a Petri dish. The Petri dish was used to cast an agargel made of physiological saline with a pH dye. The pH dye was 5% pHindicator (RC Hagen wide range). The pH indicator was added to the agargel phantom before its solidification. Three sets of 1000 V, 100microsecond long 1 Hz frequency, 99 pulses per set were deliveredbetween the central electrode and the electrode around the Petri dish.

It was observed that after the delivery of three sets of 99 pulses, with1000 V electroporation type pulses, the amount of electrolysis productsgenerated is negligible relative to that produced by DC electrolysis inthe previous examples. The isoelectric field lines which are associatedwith irreversible electroporation, above about 400 V/cm were much closerto the central electrode than the isoelectric lines of 100 V/cm.Therefore, the extent of tissue ablation with irreversibleelectroporation alone, which reached only the about 400 V/cm isoelectricfield line, was much smaller than the extent of tissue ablation with thecombination electrolysis and electroporation, which reached theisoelectric field line of 100 V/cm.

From Examples V and VI, it is observed that when a central electrode anda remote electrode are used for tissue ablation around the centralelectrode, combining electrolysis with electroporation may substantiallyexpand the region of tissue ablation near the central electrode overelectroporation alone. The various combinations of electrolysis andelectroporation sequences discussed earlier for two needle electrodesmay be valid for a central needle electrode also.

The examples provided are for explanatory purposes only and should notbe considered to limit the scope of the disclosure.

Those skilled in the art will recognize that the examples provided ofboth the design delivery systems and the clinical applications are notthe limit of the uses of the combination of electroporation andelectrolysis. Many configurations of delivery systems exist, as well asapplications that would benefit from the use of the discovery wedisclose.

It is to be appreciated that any one of the above embodiments orprocesses may be combined with one or more other embodiments and/orprocesses or be separated and/or performed amongst separate devices ordevice portions in accordance with the present systems, devices andmethods.

Finally, the above-discussion is intended to be merely illustrative ofthe present devices, apparatuses, systems, and methods and should not beconstrued as limiting the appended claims to any particular embodimentor group of embodiments. Thus, while the present disclosure has beendescribed in particular detail with reference to exemplary embodiments,it should also be appreciated that numerous modifications andalternative embodiments may be devised by those having ordinary skill inthe art without departing from the broader and intended spirit and scopeof the present disclosure as set forth in the claims that follow.Accordingly, the specification and drawings are to be regarded in anillustrative manner and are not intended to limit the scope of theappended claims.

What is claimed is:
 1. An apparatus for tissue ablation comprising: afirst electrode and a second electrode configured to provideelectrolysis; and a probe configured to provide permeabilization.
 2. Theapparatus of claim 1, further comprising a catheter including the firstelectrode, the second electrode, or both and at least a portion of theprobe.
 3. The apparatus of claim 2, wherein the catheter comprises alumen.
 4. The apparatus of claim 2, wherein the catheter comprises atleast one balloon, wherein the first electrode, the second electrode, orboth are located on a periphery of the at least one balloon.
 5. Theapparatus of claim 1, wherein the probe comprises a cryosurgery probe,an ultrasound transducer, or a combination thereof.
 6. The apparatus ofclaim 1, wherein the first electrode, the second electrode, or both arelocated on the probe.
 7. The apparatus of claim 6, wherein at least oneof the first electrode or the second electrode are further configured toperform the permeabilization by electroporation.
 8. The apparatus ofclaim 1, wherein the first electrode, the second electrode, or bothcomprise an expandable electrode, an expandable spring electrode, afixed electrode, a stent, a surface pad, or a combination thereof. 9.The apparatus of claim 1, wherein the apparatus further comprises atleast one more electrode configured to perform electrolysis,permeabilization, or a combination thereof.
 10. The apparatus of claim1, further comprising a controller configured to control a timeduration, a magnitude, or a combination thereof of the electrolysisprovided by the first electrode and the second electrode, thepermeabilization provided by the probe, or a combination thereof. 11.The apparatus of claim 10, further comprising a sensor configured tomeasure pH in communication with the controller, wherein the controlleris configured to adjust the time duration, the magnitude, or thecombination thereof of the electrolysis, permeabilization, or thecombination thereof based, at least in part, on the pH measured by thesensor.
 12. The apparatus of claim 10, further comprising a sensorconfigured to measure an electric field in communication with thecontroller, wherein the controller is configured to adjust the timeduration, the magnitude, or the combination thereof of the electrolysis,permeabilization, or the combination thereof based, at least in part, onthe electric field measured by the sensor.
 13. The apparatus of claim 1,further comprising an aqueous matrix, wherein the aqueous matrixcomprises a gel, a hydrogel, a solution, or a combination thereof. 14.The apparatus of claim 13, wherein at least a portion of the aqueousmatrix is arranged between the tissue and the first electrode or thesecond electrode.
 15. The apparatus of claim 13, further comprising areservoir configured to provide one or more compounds to the aqueousmatrix to control a pH of the aqueous matrix.
 16. The apparatus of claim1, wherein at least a portion of the first electrode, the secondelectrode, the probe, or a combination thereof is configured to beinserted into a vessel, a duct, a tube, a cavity, a lumen of a body, ora combination thereof.
 17. The apparatus of claim 16, wherein the firstelectrode is configured to be inserted into the vessel, the duct, thetube, the cavity, the lumen of the body, or the combination thereof andthe second electrode is configured to remain outside the vessel, theduct, the tube, the cavity, the lumen of the body, or the combinationthereof.
 18. A method for ablating tissue, the method comprising:positioning an apparatus comprising an electrolysis device and apermeabilization device proximate the tissue; performing electrolysis ofthe tissue with the electrolysis device; and performing permeabilizationof the tissue with the permeabilization device.
 19. The method of claim18, further comprising providing an aqueous matrix proximate the tissue.20. The method of claim 19, wherein providing the aqueous solutioncomprises injecting the aqueous matrix proximate the tissue.
 21. Themethod of claim 20, further comprising: monitoring a pH of the aqueoussolution with a pH meter; and adjusting the pH of the aqueous solutionby adding compounds to the aqueous solution.
 22. The method of claim 18,wherein positioning the apparatus proximate the tissue comprisesinserting the apparatus into a vessel, a duct, a tube, a cavity, alumen, or a combination thereof formed by the tissue.
 23. The method ofclaim 18, wherein the apparatus comprises a catheter.
 24. The method ofclaim 18, wherein the tissue comprises nerves in a lung, nerves incardiac tissue, a fibroid, a myoma, a bedsore, an ulcer, a skin cell, afat cell, or a combination thereof.
 25. The method of claim 18, whereinthe method is included in a Cox procedure.
 26. The method of claim 18,wherein performing the permeabilization comprises performingelectroporation, freezing, cooling, warming, sonication, or acombination thereof.
 27. The method of claim 16, wherein performing theelectrolysis and performing the permeabilization are performedsimultaneously.
 28. The method of claim 16, wherein the method is usedto treat chronic obstructive pulmonary disease.